Background:
The spectrum of vascular access-site complications following cardiac catheterization can vary widely in severity ranging from simple to complex that can contribute to significant morbidity with a high economic burden and healthcare costs.

Aim:
The aim of the case presentation was to describe post-discharge delayed complication (acute limb ischemia) of cardiac catheterization due to noncalcified plaque.

Case Presentation:
A 58-year-old male with a history of coronary artery disease, diabetes mellitus, and hyperlipidemia underwent cardiac catheterization status-post angioplasty to the right coronary artery via right-femoral artery access. The patient was discharged home post-procedure, however, 8 hours later, he developed a sudden-onset cold foot, and worsening numbness, and tingling sensation in his right extremity that prompted him to present to the ER. Physical examination was notable for cold skin in his right leg with diminished dorsalis pedis and popliteal pulses, and a mild loss of “touch sensation” below the level of the knee. The patient was staged “IIa” on the Rutherford Acute Limb Ischemia score. Vitals and labs were within normal limits. CT Angiogram revealed focal high-grade stenosis in the right common femoral artery at the site of a recent arterial puncture from cardiac catheterization. This was likely secondary to nonocclusive, noncalcified plaque that has been disrupted from recent instrumentation. A Heparin drip was initiated and the patient underwent emergent revascularization with a diagnostic angiogram and balloon angioplasty of the right common femoral artery with the placement of a 27mm stent. A completion angiogram showed the resolution of the high-grade stenosis with good flow through the profound and superficial femoral artery. 

Discussion:
The risk of access-site complications following cardiac catheterization, although quite low, is increased with the femoral artery with an incidence estimated to be as high as 17%. Bleeding and hematoma are often reported, however, thrombosis is infrequent with mechanisms involving atherosclerotic plaque rupture or subintimal dissection of the plaque with secondary thrombosis. When the severity of limb ischemia is threatening, immediate anticoagulation followed by surgical revascularization is the most appropriate intervention. Thrombosis at the access site of cardiac catheterization can cause critical limb ischemia, particularly with the femoral artery, thus highlighting the need for careful post-operative follow-up. 


Acute limb ischemia due to iatrogenic plaque rupture in the common femoral artery at the site of cardiac catheterization - A Case Report

 Cardiology

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Acute limb ischemia due to iatrogenic plaque rupture in the common femoral artery at the site of cardiac catheterization - A Case Report

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